HEALTH SYSTEM THINKING
Since independence, the Government of Tanzania thrives to ensure high quality, accessible and affordable health services to the population. The Government has been undertaking many reforms in the health system financing structure including the provision of free health care services and the introduction of cost sharing in 1993. The introduction of cost sharing was a response to constraints in the ability of the Government to generate adequate revenue to fund health care needs for the whole population. The cost sharing policy requires everyone with the ability to pay, to contribute to the cost of health services except special groups which are exempted. The exempted groups include the poor, children under five, pregnant women and people with chronic illness. The introduction of cost sharing was followed by the establishment of prepayment schemes, starting with the Community Health Fund (CHF), which was piloted from 1996 in Igunga district and consequentially its respective Act was passed in to law in 2001.
The National Health Insurance Fund (NHIF) was also established in 1999. The objective was to increase resources to the health sector and ensure availability of needed health services at the point of need to the entire population, while protecting families from catastrophic health care expenditure regardless of social economic status.
Specifically, the CHF scheme was established with the objectives of:
Mobilizing financial resources from the community through a sustainable financial mechanism for the provision of adequate quality and affordable health care services to its members,
Improve health care services management in the community through decentralization by empowering the community in making decisions by contributing on matters affecting their health through the establishment of governance organs including CHSBs and HFGCs.
For the past fifteen odd years, CHF was implemented by district councils, which were mandated by the CHF Act to establish the scheme and reinforce the CHF bylaws. There have been notable successes and challenges during the CHF implementation. Challenges of the original CHF design and lessons from the pilot regions have led to developing of a strategy for CHF reform, which was to be implemented in phases. The current first phase involves the introduction of new management structures and fund pooling at regional level. The second phase will implement long term interventions for the development of a Single National Health Insurance scheme, as a long-term plan for achieving UHC. However, because the Act will have to go through number of Government procedures, it is expected that it will require a long time for it to be implemented.
Therefore, the Government has prepared a short term plan to ensure that all, especially those in the informal sector which constitute a large percent of the total population, are covered by the prepayment scheme of the reformed CHF iliyoboreshwa while procedures for establishing the Single National Health Insurance are being implemented.
The main objective of improving governance structures of CHF target to alleviate the challenges from the old CHF structure with the focus of effectively embed CHF in the existing governance structures; concretize functions of oversight committees at village, ward and facility levels put in place incentives for effective governance of CHF. The structures are improved for administration and reporting in the context of the proposed purchaser-provider split as well as accountability mechanisms and governance structures including NHIF roles. A functioning CHF management/administration structure has been established at RAS Offices down to village levels, including financial and membership management whereby each region opens and manage separate CHF account for collection of revenues and payment of health services providers and for administration of CHF operations.
HPSS project ensures structures put in place for management of CHF iliyoboreshwa are supported and the Government is properly advised to develop and introduce effective management systems to ensure both financial and non-financial aspects of CHF are well managed. The project supports the Government of Tanzania in developing and further strengthening Social Health Protection and Health Financing Policies and Systems in Tanzania to allow equitable access to health through Universal Health Insurance Coverage with feasible and sustainable pro-poor financing mechanism, and an Insurance Management Information System IMIS integrated into other essential ICT systems in the health sector.
The HPSS project supports districts to improve public financial management practices leading to increased efficiency and to facilitate smooth flow of financial resources to health facilities.
The focus is on policy level and institutional aspects in the area of health financing and social health protection. In particular, the emphasis is on institutional capacity building and further anchorage of “HPSS products” in the Tanzanian policy environment and health system to maximize the potential for the project’s work to be sustained beyond the project’s own timeframe.
The project has made a considerable investment to build a Resource Centre so it can lead the continued supporting completion of national roll-out of the CHF and development of a professional management structure at national level. In this regard, HPSS continue to work with the Government and with other development partners to put in place mechanism for a viable and self-sustaining health insurance system for informal sector and rural population in all 26 regions of Tanzania mainland.